Trauma model of mental disorders

The trauma model of mental disorders, or trauma model of psychopathology, emphasizes the effects of psychological trauma, particularly in early development, as the key causal factor in the development of some or many psychiatric disorders, or a vulnerability for depression and anxiety,[1] in addition to trauma as an adult as in post-traumatic stress disorder.

Trauma models are typically founded on the view that traumatic experiences (such as actual physical or sexual abuse) are more common or more serious than thought in the histories of those diagnosed with mental disorders. Such models have traditionally been associated with psychoanalytic approaches, notably Sigmund Freud's early ideas on childhood sexual abuse and hysteria.

John Bowlby, who developed attachment theory, also describes the negative mental health consequences, based on his observations, of the effects on infants and young children when a positive relationship with a caregiver is lacking.[2] In addition there is significant research supporting the linkage between early experiences of chronic maltreatment and later problems.[3]

In the 1960s trauma models also became associated with humanist and anti-psychiatry approaches, particularly in regard to understanding schizophrenia and the role of the family.[4] Personality disorders have also been a focus, particularly borderline personality disorder. Extreme versions of trauma models have implicated the fetal environment and the trauma of being born, or have been associated with recovered memory controversies.

More generally, trauma models highlight particularly stressful and traumatic factors in early attachment relations and in the development of mature interpersonal relationships. They are often presented as a counterpoint to a psychiatry claimed to be too focused on genetics, neurochemistry and medication.

History

In the 1940s to the 1970s, some mental health professionals proposed trauma models to understand schizophrenia: Harry Stack Sullivan, Frieda Fromm-Reichmann, Theodore Lidz, Gregory Bateson, Silvano Arieti, R.D. Laing and others. They held that schizophrenia is induced by experiences in profoundly disturbed families or by attempts to cope with a damaging society. In the 1950s, Sullivan's theory that schizophrenia is related to interpersonal relationships was widely accepted in the United States.

The Diagnostic and Statistical Manual of Mental Disorders, or DSM, does not claim that the specific etiology of schizophrenia and other serious psychoses has been established. However, the psychogenic models proposed by these early researchers such as the "schizophrenogenic mother" are no longer accepted in the psychiatric profession. Since the 1960s, pharmacological treatments became the increasing focus of psychiatry, and by the 1980s, the theory that the family dynamics could be implicated in schizophrenia became unacceptable in Germany.[5]

Before his death in 2001, at 90, Lidz, one of the main proponents of the "schizophrenogenic" parents theory, expressed regret that current research in biological psychiatry is "barking up the wrong tree".[6] Like Lidz, Laing maintained until his death that the cause of both schizoid personality disorder and schizophrenia was influenced by family relationships.

In 1975, Silvano Arieti won the American National Book Award in the field of science for his book, Interpretation of Schizophrenia, which advances a psychological model for understanding all the regressive types of the disorder.[7] According to more recent research, child abuse at home plays a causal role in depression, PTSD, eating disorders, substance abuse and dissociative disorders.[8]

The more severe the abuse the more probability symptoms will develop in adult life.[9] In the psychiatric field it is hypothesized that child abuse is less related to the most serious psychoses, such as schizophrenia. However, some mental health professionals maintain that the relationship is stronger in psychoses than neuroses.[10]

Critical argument

Critics of the model, such as August Piper Jr., argue that the logic of the claim that childhood trauma causes insanity demonstrates a serious flaw. If the claim were true, critics contend, the abuse of millions of children over the years should have caused many cases of insanity; but no evidence exists.[11]

Arieti stated that the only persons before whom young human beings are vulnerable are the ones to whom they are emotionally bonded in childhood. A passage of Interpretation of Schizophrenia, originally published in 1955, sheds light on the heart of the trauma model:

“ First of all we have to repeat here what we already mentioned..., that conditions of obvious external danger, as in the case of wars, disasters, or other adversities that affect the collectivity, do not produce the type of anxiety that hurts the inner self and do not themselves favor schizophrenia. Even extreme poverty, physical illness, or personal tragedies do not necessarily lead to schizophrenia unless they have psychological ramifications that hurt the sense of self. Even homes broken by death, divorce or desertion may be less destructive than homes where both parents are alive, live together, and always undermine the child's conception of himself.[12] ”

Recent approaches

Psychiatrist Colin Ross calls his model, "trauma model of mental disorders", which addresses comorbidity of trauma with other mental disorders. Ross describes the theoretical basis of his trauma model as common sense: "The problem faced by many patients is that they did not grow up in a reasonably healthy, normal family. They grew up in an inconsistent, abusive and traumatic family. The very people to whom the child had to attach for survival, were also abuse perpetrators and hurt him or her badly.... The basic conflict, the deepest pain, and the deepest source of symptoms, is the fact that mom and dad's behavior hurts, did not fit together, and did not make sense."[13]

In 2006, a UK researcher and a New Zealand clinical psychologist presented a controversial meta-analysis of schizophrenia studies[14] that stated the prevalence of physical and sexual abuse in the histories of those with schizophrenia is very high and is being understudied. The researchers stated that not all cases of schizophrenia are caused by trauma, but they believe "the level of actual abuse may be an important difference". Genetics remains a causative risk factor, but "other evidence shows that genes alone do not cause the illness".[15][16]

In the field of criminology, Lonnie Athens developed a theory of how a process of brutalization by parents or peers that usually occurs in childhood results in violent crimes in adulthood. Richard Rhodes's Why They Kill describes Athens's observations about domestic and societal violence in the criminals' backgrounds. Both Athens and Rhodes reject the genetic inheritance theories.[17]

Criminologists Jonathan Pincus and Dorothy Otnow Lewis believe that although it is the interaction of childhood abuse and neurological disturbances that explains murder, virtually all of the 150 murderers they studied over a 25-year period had suffered severe abuse as children. Pincus believes that the only feasible remedy for crime would be the prevention of child abuse.[18]

A 2012 review article supports the hypothesis that current or recent trauma may affect an individual's assessment of the more distant past, changing the experience of the past and resulting in dissociative states.[19] A review of factors that influence the risk for the common mental disorders proposed trauma as a shared risk factor.[20][21]

See also

References

  1. ↑ Jeronimus, B.F., Ormel, J., Aleman, A., Penninx, B.W.J.H., Riese, H. (2013). "Negative and positive life events are associated with small but lasting change in neuroticism". Psychological Medicine. 43 (11): 2403–15. doi:10.1017/s0033291713000159.
  2. ↑ Cassidy, J., & Shaver, P., (Eds). (1999) Handbook of Attachment: Theory, Research, and Clinical Applications. Guilford Press, NY
  3. ↑ Main, M. & Hesse, E. (1990). "Parents' unresolved traumatic experiences are related to infant disorganized attachment status: Is frightened and/or frightening parental behavior the linking mechanism?" In Greenberg, M., Cicchetti, D., and Cummings, M. (Eds.), Attachment In The Preschool Years: Theory, Research, and Intervention. Chicago: University of Chicago Press.
  4. ↑ Lilienfeld, Scott (1995). "Will the real pseudoscientists please stand up?". Skeptical Inquirer. November/December: 45.
  5. ↑ Hahlweg, K; et al. (2000). "Familienbetreuung als verhaltenstherapeutischer Ansatz zur Ruckfallprophylaxe bei schizophrenen Patienten", in M. Krausz, D. Naber (eds.) Integrative Schizophrenietherapie. Freiburg: Karger.
  6. ↑  – article on Theodore Lidz
  7. ↑ associazionesilvanoarieti.org – page on Arieti (mostly in Italian)
  8. ↑ Kendler, K; et al. (2000). "Childhood sexual abuse and adult psychiatric and substance use disorders in women". Archives of General Psychiatry. 57 (10): 953–959. doi:10.1001/archpsyc.57.10.953. PMID 11015813.
  9. ↑ Mullen, P. E.; et al. (1993). "Childhood sexual abuse and mental health in adult life". British Journal of Psychiatry. 163 (6): 721–32. doi:10.1192/bjp.163.6.721. PMID 8306113.
  10. ↑ Davies, Emma; Jim Burdett (2004). "Preventing 'schizophrenia': creating the conditions for saner societies" in Read et al., Models of Madness. Routledge.
  11. ↑ Piper, August (1998). "Multiple Personality Disorder: Witchcraft Survives in the Twentieth century". Skeptical Inquirer. May/June.
  12. ↑ Arieti, Silvano (1994). Interpretation of Schizophrenia. Aronson. p. 197.
  13. ↑ – Colin Ross' web site
  14. ↑ Read J, van Os J, Morrison AP, Ross CA (November 2005). "Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications". Acta Psychiatr Scand. 112 (5): 330–50. doi:10.1111/j.1600-0447.2005.00634.x. PMID 16223421.
  15. ↑ "Media report of sexual abuse as cause of schizophrenia". Retrieved 2009-04-15.
  16. ↑ "Maudsley debate on sexual abuse as a cause of schizophrenia". Retrieved 2009-04-15.
  17. ↑ Rhodes, Richard (2000). Why They Kill: The Discoveries of a Maverick Criminologist. Vintage. ISBN 0-375-40249-7.
  18. ↑ Pincus, Jonathan (2002). Base Instincts: What Makes Killers Kill. W.W. Norton & Company. ISBN 0-393-05022-X.
  19. ↑ Stern DB (January 2012). "Witnessing across time: accessing the present from the past and the past from the present". The Psychoanalytic Quarterly. 81 (1): 53–81. doi:10.1002/j.2167-4086.2012.tb00485.x. PMID 22423434.
  20. ↑ Ormel J.; Jeronimus, B.F.; Kotov, M.; Riese, H.; Bos, E.H.; Hankin, B. (2013). "Neuroticism and common mental disorders: Meaning and utility of a complex relationship". Clinical Psychology Review. 33 (5): 686–697. doi:10.1016/j.cpr.2013.04.003. PMC 4382368Freely accessible. PMID 23702592.
  21. ↑ Malouff, J.M., Thorsteinsson, E.B., & Schutte N.S. (2005). "The relationship between the five factor model of personality and symptoms of clinical disorders". Journal of Psychopathology and Behavioral Assessment. 27 (2): 101–114. doi:10.1007/s10862-005-5384-y.

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